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Darlington Oral Health Plan2017-2022
2 Darlington Oral Health Plan 2017-2022
ContentsVision, Aim, Objectives 3
Key messages 4
Introduction 5
Oral health in children 6
Oral health for older people in residential care 8
Epidemiological assessment of need in children 10 and young people
Findings on oral health from the Healthy 16 Lifestyle Survey in Darlington (HLS)
Epidemiological Assessment of oral health need 17 for older people in care homes in Darlington
Oral cancer 17
Attendance at NHS dentists 20
Oral health action plan 21
Aim To improve oral health and reduce inequalities of children, young people and older people in residential and nursing care homes in Darlington by identifying priority actions, developing recommendations and key plans.
Objectives Review routinely available epidemiological evidence on dental disease in children and that in older
people residing in care in Darlington. Support the 0-19 Healthy Children provider to integrate oral health in prevention and early
intervention programmes Support commissioners in the local authority to incorporate oral health in contracts with care homes. To enable and support a Making Every Contact Count (MECC) approach for health and social care
staff to make use of opportunities to provide advice on oral health and signposting to dental services when necessary.
Vision The vision is for the population in Darlington to have good oral health. This will be achieved by integrating oral health in other relevant plans and reducing oral health inequalities. Our focus is on children, young people and older people in residential care homes.
Darlington Oral Health Plan 2017-2022 3
1. PHE 2015 (d): Public Health England (PHE). North Yorkshire and Humber oral health needs assessment 2015. Published: September 2015. PHE publications gateway number: 2015317. 0
2 201 20 201 20 20 2020 20201
200 0 2011 12 201 1201 201 20 1
12000001 102 0 0000 120 1 0 201201 2 2 2
2011 122012 2012
2012 09 2012 09
1. Key Messages
Tooth decay is a predominantly preventable disease. A healthy diet and good oral hygiene are the best preventative measures in tackling dental decay.
decay and socioeconomic deprivation1.
Oral health interventions that support and
found to be among the most cost-effective in reducing dental decay.
sits towards the top of the hierarchy of evidence in terms of quality, design and rigour. The evidence includes a large proportion of systematic and other substantive reviews. The
which looked at general health effects, that
third of children have several decayed teeth2.
health and have an action plan to address any
part of the statutory health assessments for children in care.
There has been no measurable improvement in
year-old children in Darlington over the past few years, a trend not always observed in the
free from dental decay3). Darlington has a mortality rate of oral cancers
(age standardised per 100,000) that is
and other local authorities in the North East4.This is most likely linked to late diagnosis as well as lifestyle behaviours and poverty.
There is evidence that some older people living in residential and nursing care homes have
dentures5. There is strong evidence linking poor
oral health and malnutrition to aspiration pneumonia in frail older people6.
An ageing population, especially the most vulnerable with dementia residing in care
health care provision.
to assess their local population’s oral health needs and commission oral health improvement programmes to meet that need7.
4 Darlington Oral Health Plan 2017-2022
2. Introduction
Oral disease is an important public health issue because of its impact on the individual and society, the cost of treatment and because it is largely preventable. Poor oral health shares common risk factors with a number of chronic diseases. Socioeconomic deprivation and high levels of sugar consumption are risk factors for both dental decay and obesity. This oral health plan has been developed in parallel to a children and young people healthy weight plan and local action on sugar.
adults in England has improved. However, this overall improvement masks huge inequalities in the population. High risk and vulnerable groups include the socioeconomically deprived; institutionalised adults such as those in residential care or prison as well as those with disabilities and mental illness. Such groups still suffer from poor oral health and have variable access to dental care.
The plan focuses on a system wide approach and on an integrated partnership delivery to embed oral health improvement in different programmes and at a strategic level to achieve sustainable
actions that are supported by a strong evidence base as described in the Public Health England/Department of Health guidance “Delivering better oral health: an evidence-based toolkit for prevention”8
guidance (PH55) “Oral health: local authorities and partners”9.
Darlington Oral Health Plan 2017-2022 5
201 0 2better_oral_health.pdf
9 201
Councillor Andrew Scott
3. Oral Health in Children
Oral health is essential to general health and quality of life. Dental decay is one of the most common non-communicable childhood diseases, and it is largely preventable. A healthy diet and good oral hygiene are the best preventative measures in tackling dental decay. Poor oral health can have detrimental consequences on children and young people’s physical and psychological wellbeing. The effects of dental diseases on children and young people
and impaired nutrition and growth which all have a detrimental impact on a child’s quality of life and overall health and wellbeing10.
201 201of teeth because of tooth decay was the most common reason for hospital admission for
9
years and under11. Usually a general anaesthetic is
Oral health interventions that support and
to be among the most cost-effective in reducing dental decay.
PHE estimates that after 5 years, the Return on
0 1 101
After 5 years, targeted supervised tooth brushing 2
per 5,000 children12.
Groups who are at a high risk of dental disease include children and young people from low socio economic groups; Children and young people with special needs, including children and young people
and young people; the Gypsy, Roma and traveller population and young offenders13.
10 201 0 19dental-health-issues-at-a-local-level
11. Royal College of Surgeons (2015). Children hospitalised unnecessarily from tooth
events/media-centre/press-releases/children-hospitalised-unnecessarily-from-tooth-decay
12 201www.gov.uk/government/publications/improving-the-oral-health-of-children-cost-effective-commissioning
13. https://www.gov.uk/government/publications/health-matters-child-dental-health/health-matters-child-dental-health
6 Darlington Oral Health Plan 2017-2022
3. Oral Health in Children
Health behaviours have been found to account for a modest proportion of the variance in the differences in oral health by socioeconomic position14. Focusing solely on individual behaviour
wider determinants of health and on a partnership delivery to achieve sustainable improvements in population oral health15.
Following the implementation of the Health and Social Care Act 2012, responsibilities for oral health improvement and oral health promotion lie
As part of their statutory duties, local authorities have commissioning responsibilities to provide oral health promotion programmes, undertake oral health surveillance and surveys and fund
1 200 1 1 91 2 201
Darlington Oral Health Plan 2017-2022 7
4. Oral Health for Older People in Residential Care
The plan includes oral health for older people in care homes in order to reflect national guidance taking into account the complex oral healthcare needs of older people living in care homes in Darlington. This is timely for the following reasons: Older people are retaining their natural dentation for longer. Restorations such as multi-unit bridges and implants pose huge challenges for the frail elderly in residential care settings, especially those who cannot self-care and have to rely on others to maintain good oral hygiene and additional dental care for unrestored teeth.
mean that older people are surviving multiple chronic illnesses and most likely will be on multiple medications. This has implications for oral health care provision as that may create more demand on specialist services as well as the need to take into account the side effects of certain medications when providing dental treatment (e.g. anticoagulant and antiplatelet medications). Additionally, the side effects of certain medications may also compromise oral health; for
and Alzheimer disease medications) or oral candidiasis (e.g. some inhalers for asthma)16.
Similar to demographic trends observed in other North East local authority areas, Darlington has an increasingly ageing population. Predictions
20 21100 201 29100in 2035)17.
The percentage increase in the total population
without nursing in Darlington between 2017 and 20 9 201 1This is higher than the percent increase at a
1projected nationally in England during the same
18.
to provide accommodation to an increasing and 0
older people, especially those with dementia, multiple morbidities and highly restricted mobility.
1 200 22 111
8 Darlington Oral Health Plan 2017-2022
4. Oral Health for Older People in Residential Care
201 201 1 9201 2 1 20 19. Dementia makes providing oral healthcare quite challenging.
communication; lack of capacity to consent and
dental treatment or even tooth brushing. Other challenges include misplacing dentures.
There is evidence that older people living in residential and nursing care homes have more
dentures than peers who live elsewhere. A high proportion of older people living in care homes are often dependant on others for their diet, personal care and access to dental treatment. The diet in care homes usually comprises frequent use of sugars20.
There are no “off-the-shelf” routine data to inform the epidemiological dental needs of the
and care homes.
1920. https://www.nice.org.uk/improving-oral-health-for-adults-in-care-homes
Darlington Oral Health Plan 2017-2022 9
Appendix 1Epidemiological Assessment of Need in Children and Young People
10 Darlington Oral Health Plan 2017-2022
A commonly used indicator of tooth decay, the
average number of decayed (d), missing due to
12reports the adult teeth in upper case (DMFT). The average (mean) dmft/DMFT is a measure of
This measure can be used to assess individual oral health or that of a community. A child who has 5 teeth affected by dental disease will have a dmft of 5. A population of 100 children where 50 of them have one tooth affected by dental disease will have a population dmft of 0.5. However, the
of children with a high level of dental disease can result in a misleading level within a community.
a community by the proportion of children in a population free from dental disease21.
The prevalence and severity of oral disease at
impact of early year’s services and programmes to improve parenting, weaning and feeding of very young children22.
According to the 2015 national dental epidemiological survey of 5 year olds , the
who were free from visually obvious dental decay 0
that reported in the North East of England of 2 2
201
more teeth that were decayed to dentinal level,
02
2
Although the overall trend for tooth decay in 5 year olds is one of reduction nationally, regionally and in most local areas, this has not been the case for this age group in Darlington. Not only did oral health PHO indicators for 5 year olds in Darlington lag behind those of children their age nationally and regionally, but data from PHE show a worsening trend for Darlington with a
201 02012 1 0 29
The comparable trend in England has been one of improvement.
21 2011 1222 201 1 12000001 102 0 00000 92 0
Table 1: Proportion of five year old children with dental decay in Darlington and other Tees Valley local authorities and percentage change between 2012-2015 and 2008 to 2015 (data source: NHS Dental Epidemiology Programme for England, Oral Health Surveys of 5 year old children 2007/08; 2011/12 & 2014/15) 24
Darlington Oral Health Plan 2017-2022 11
Figure 1: Trend in percentage of 5 year olds with obvious decay experience in Darlington and other Tees Valley Local authorities (% d3mft >0)23
The proportion reduction in the prevalence of dental caries in 5 year olds in Darlington (2008 2015)
1the prevalence of dental caries among 5 year olds between 2012 and 2015.
2008/09 2011/2012 2014/2015 reduction in caries prevalence between 2012- 2015
reduction in caries prevalence between 2008- 2015
England 0 90 2 90 2 0 20 20
Hartlepool 0 19 0 1 0 20 1 0
Middlesbrough 0 1 0 0 2 0 1 0
Darlington 9 0 2 20 0 20 20
Redcar and Cleveland
9 0 90 2 10 0 12 0
Stockton-on-Tees 90 1 90 2 0 0 1 0
2 200 0 2011 12 201 1graph: Dr. Frederike Garb, Oral health needs assessment in Northumberland
2
12 Darlington Oral Health Plan 2017-2022
2 201children in Darlington who were free from visually
01 2
2 9
water is a key factor for the reported lower levels of dental decay.
2 1 12000001 101 0 00000 92 00 2
Figure 2: Proportion of five year old children free from dental decay 2014/15 (PHOF indicator 4.02)25
Figure 3: Proportion of five year old children free from dental decay (2014/15) - CIPFA nearest neighbours
Darlington Oral Health Plan 2017-2022 13
2 19 1 0 12000001 101 0 00000 92 0
The overall prevalence rates of dental decay in children aged 5 years old reported in Darlington mask inequalities.
The results from the Department of Health in England surveys of the oral health of 5 year old children in state schools in Darlington which were analysed by Dental Public Health in PHE in 2013 showed wide variations in mean DMFT (tooth decay) between children aged 5 years olds living in Darlington wards.
2various wards in Darlington and the proportion of children with tooth decay.
According to the table, the average dmft in 5 year olds in 2013 in electoral wards in Darlington
0 1 2to demonstrate the socioeconomic patterning of dental decay.
One has to note that these data need to be interpreted with caution because of the small numbers of children seen in each ward and the requirement for positive consent (opt in) may have introduced bias into the data and there have been changes in the boundaries of electoral wards since the original analysis.
Figure 4: Trend in percentage of 5 year olds with obvious decay experience in Darlington and other Tees Valley Local authorities (% d3mft >0)26
14 Darlington Oral Health Plan 2017-2022
2 2011 121
data has been suppressed, wards are white).229 19 1 0
12000001 101 0 00000 92 00 2
0 19 1 012000001 101 0 00000 92 00 2
1 19 1 012000001 101 0 00000 92 00 2
Figure 5: Proportion of 3-year-old children with no obvious dental decay 2012-2013 (data source: Dental Public Health Epidemiology Programme for England: oral health survey of three-year-old children 2013)31
Table 2: dmft for 5 year old children in selected electoral wards in Darlington Borough Council (source: PHE, 2013)27
Ward name Children examined Children selected Proportion seen dmft
38 1.7
25 9 1 1.9
53 2.2
50 72 9 0.5
9 9 1 1.1
2 35 0
32 1 0
32 57 2.7
9 2 1.5
2 2 0.1
2 0 0.8
The percentage of children aged 5 years in 201
2 11 2 2 28.
The best oral health indicators seen in children and young people in Darlington are those for three year olds. The proportion of 3-year-old children with no obvious dental decay in 2012-2013 in Darlington was higher than that in England and
29.
12children that had decay on average had 3.07 teeth
0 201 30
Darlington Oral Health Plan 2017-2022 15
12national average. For those 12 year old children with tooth decay, on average, each child had 1.19
Figure 6: Proportion of twelve year olds free from dental decay 2008/09
Figure 7: Average number of decayed, missing or filled teeth (dmft) in twelve year olds DMFT in twelve year olds 2009 CIPFA
Appendix 2Findings on Oral Health from the Healthy Lifestyle Survey in Darlington (Primary and Secondary Schools)
201 1201 201
with 15 primary schools in Darlington submitting 1
Four questions in this survey relate to oral health.
The key findings include
Half of respondents eat sweets and chocolate daily
1
teeth removed
21 1 199
2
respondents reported visiting a dentist only when they had toothache.
A little over a third of respondents reported
teeth Out of the 1,195 primary school children
who answered the question on how often they 1
their teeth weekly, sometimes or never.
19 00 How
often do you go to the dentist?
121922 0
11
1570 have had a tooth/teeth taken out 1
none of these.
16 Darlington Oral Health Plan 2017-2022
Darlington Oral Health Plan 2017-2022 17
There are no “off-the-shelf” routine data to inform the epidemiological dental needs of
residential and care homes.
More older people are retaining their natural teeth for longer and hence a larger number of older people in the North East will have a high number of heavily restored teeth
older in the North East who were edentulous and surveyed as part of the Adult Dental Health Survey 200932.
Oral Cancer Oral cancer is an umbrella term that includes any cancer of the lip, tongue and rest of the oral
glands.33 Oral cancer is not very common in the UK. However, over the last decade in the UK, oral
9The incidence is directly proportional to patient age, with half of new diagnoses annually being
The lifetime risk of developing oral cancer also
being double that for women (1 in 75 for men, and 1 in 150 for women).34
age standardised incidence of oral cancer is not
(see Figure 9).
Oral cancer registration is viewed as a direct measure of smoking-related harm because a high proportion of these registrations are due to smoking.35 Hence, interventions that result in a reduction in the prevalence of smoking would reduce the incidence of oral cancer.
Appendix 3Epidemiological Assessment of Oral Health Need for Older People in Care Homes in Darlington
Table 3: Proportion of the population aged 65 and older in the North East who were edentulous (i.e. without teeth)
Age Band % edentulous (i.e. without teeth)
19.7
2 2009 20112010
2010 9 1 90 92 00dentists/policy-campaigns/public-health-science/public-health/Documents/early_detection_of_oral_cancer.pdf
One20
1 12000001 102 0 0000 120 1
The main risk factors associated with the development of oral cancers, are smoking or
suggests that lower socio-economic status is a
of lifestyle behaviours. People in more deprived areas are more likely to have oral cancer and more likely to have poorer outcomes. This is mainly related to irregular attendance at the dentist and hence delayed diagnosis.
Over the last decade in the UK (between 2003-200 2012 201
20 19for females).36 37 However, survival rates for oral cancers have been rising over the last two decades. According to
090
0cancer will survive for 5 years or more following diagnosis.38 Mortality rates from oral cancer in
201 20
Survival rates are generally closely linked to the stage of the cancer at the time of diagnosis, with higher 5 year survival rates observed at the early stages of diagnosis (stage 0,1 and 2) and lower survival rates observed in late
Figure 9, Darlington has a mortality rate of oral cancers (age standardised per 100,000) that is
other local authorities in the North East. This is most likely linked to late diagnosis.
18 Darlington Oral Health Plan 2017-2022
Figure 8: Oral cancer registrations- standardised rate per 100,000 population 2013-2015 (CIPFA)39
200020 1
12000001 102 0 0000 929 138. http://www.cancerresearchuk.org/about-cancer/type/mouth-cancer/treatment/statistics-
and-outlook-for-mouth-cancers
9 201 20120 1
12000001 102 0 0000 120 1 0October 2017)
Darlington Oral Health Plan 2017-2022 19
Figure 9: Oral cancer mortality-directly age standardised per 100,000 population (CIPFA) 2014-16
Appe
ndix
5
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Appendix 4Attendance at NHS Dentists
At a national level in England, the number of children seen by NHS dentist to the period until 31st 20122 2 2 1 201
1
seen privately which for children in Darlington is thought to be low.
20 Darlington Oral Health Plan 2017-2022
Table 4: Patients seen by an NHS dentist as a percentage of the population, by local authority, in the period ending December 201640
Local Authority % of child (0-17) population seen in previous 12 months
% of adult (18+) population seen in previous 24 months
South Tyneside 81 83
Middlesbrough 71
Stockton-on-Tees 58
Newcastle upon Tyne 58
Darlington 1
Northumberland
North Tyneside 2
Redcar and Cleveland 1 1
Sunderland 53
County Durham 53Hartlepool 0
Appe
ndix
5
Ora
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lth
Actio
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evid
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of ac
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to
impr
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oral
hea
lth
in
Dar
lingt
on a
nd red
uce
heal
th in
equa
lities
Inte
grat
e an
d st
ream
line
reco
mm
enda
tions
in t
he
oral
hea
lth
plan
with
th
ose
in t
he h
ealthy
weigh
t ac
tion
plan
for
ch
ildre
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d yo
ung
peop
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An o
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n pl
an e
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by
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com
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in D
arlin
gton
Bor
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Cou
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and
shar
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with
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lth
and
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l Be
ing
Boar
d pa
rtne
rs
A ke
y fo
cus
on s
ugar
re
duct
ion
as p
art
of a
n in
tegr
ated
ora
l hea
lth
and
heal
thy
weigh
t ac
tion
plan
for
chi
ldre
n an
d yo
ung
peop
le in
th
e Bo
roug
h.
Impr
ovem
ent
of o
ral h
ealth,
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duct
ion
of d
enta
l dec
ay in
ch
ildre
n an
d yo
ung
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le in
Dar
lingt
on a
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tegr
atio
n of
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al h
ealth
in c
ontr
acts
with
co
mm
ission
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1) Dec
line
in t
ooth
dec
ay
olds
2) Re
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ion
in e
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to
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r in
chi
ldre
n di
et
Impr
oved
offer
of info
rmat
ion,
ad
vice
and
sup
port
to
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ilies
, pa
rent
s, c
arer
s with
res
pect
to
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ucing
suga
r in c
hild
ren’s
diet
s.
3)
Impr
oved
acc
ess
to
info
rmat
ion
to s
uppo
rt
prof
ession
als
in
cont
ribut
ing
to red
ucin
g su
gar
in c
hild
ren’
s di
ets
(to
mea
sure
impa
ct o
f in
terv
entio
ns t
o re
duce
ex
posu
re t
o su
gar,
tack
le
over
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t an
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an
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prov
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al h
ealth)
.
Laun
ch/s
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Apr
il 2018
Long
ter
m
outc
ome
Info
rmat
ion
prep
ared
in
June
2018
Publ
ic H
ealth
Team
Publ
ic H
ealth
Team
Early
Year
s Pr
actit
ione
rs
incl
udin
g Hea
lth
and
Early
Hel
p,
Early
Year
s an
d Ed
ucat
ion
Prov
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s in
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19
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lthy
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lic p
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Darlington Oral Health Plan 2017-2022 21
No
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Des
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ide
health
y ea
ting
thro
ugh
appl
icat
ion
of
existin
g gu
idel
ines
and
in
terv
entio
ns p
artic
ular
ly
thos
e ar
ound
sug
ar
redu
ctio
n.
Ensu
re o
ral h
ealth
to
be p
art
of c
are
plan
s fo
r ol
der
peop
le in
car
e ho
mes
and
upt
ake
of o
ral
health
tra
inin
g by
car
e st
aff.
A re
sour
ce g
uide
ha
s be
en d
evel
oped
al
ongs
ide
the
oral
he
alth
pla
n. It
sum
mar
ises
evide
nce
base
d m
essa
ges
and
sign
post
to
serv
ices
an
d re
sour
ces
for
oral
he
alth
pro
mot
ion
in
early
year
set
tings
.
A re
sour
ce in
clud
ing
a lis
t of
key
evide
nce
base
d m
essa
ges
arou
nd
oral
hea
lth
prom
otio
n fo
r ol
der
peop
le in
car
e ho
me
Redu
ctio
ns in
chi
ldre
n to
oth
deca
y le
vels
Incr
ease
d nu
mbe
rs o
f ch
ildre
n ac
cess
ing
NHS
dent
al s
ervice
s
Ora
l hea
lth
asse
ssm
ents
an
d m
outh
car
e pl
ans
for
olde
r re
side
nts
of c
are
hom
es in
clud
ed a
s pa
rt o
f co
ntra
ctua
l res
pons
ibilitie
s
June
2018
2019
May
2018
019
Serv
ice
(HDFT
)
And
Early
Year
s pa
rtne
rs
Com
mission
ers
and
cont
ract
tea
m in
ad
ult
and
social
ca
re
Car
e ho
me
man
ager
s
Hea
lth E
duca
tion
Engl
and
With
in t
he
existin
g en
velo
pe o
f fu
ndin
g
With
in t
he
existin
g en
velo
pe o
f fu
ndin
g
2. C
reat
e su
ppor
tive
env
ironm
ents
No
No
Key
Area
of
Action
Key
Area
of
Action
Des
ired
Out
puts
Des
ired
Out
puts
Expe
cted
Out
com
es
Expe
cted
Out
com
es
Mile
ston
es
Mile
ston
es
Resp
onsi
bilit
ies
Resp
onsi
bilit
ies
Fund
ing
Posi
tion
Fund
ing
Posi
tion
3a
4a
Use
soc
ial m
arke
ting
met
hods
to
prom
ote
or
al h
ealth
mes
sage
s with
in a
ran
ge o
f se
ttin
gs.
Prom
ote
Smile
Wee
k
Use
the
PHE
guid
ance
“D
eliver
ing
bett
er o
ral
health
” Ea
rly Y
ears
se
ttin
gs in
clud
ing
advice
ab
out
oral
hea
lth in
ro
utin
e co
ntac
ts a
nd
info
rmat
ion
arou
nd
health
, wel
lbeing
, sug
ary
snac
ks a
nd d
rinks
, die
t, nu
triti
on a
nd p
aren
ting.
Dev
elop
a ran
ge o
f m
essa
ges
incl
udin
g fo
r di
ssem
inat
ion
thro
ugh
social
med
ia t
hat
prom
ote
key
elem
ents
of
Ora
l and
Den
tal
Hea
lth
prom
otio
n with
co
mm
unicat
ions
tea
m
Key
mes
sage
s ba
sed
on t
he P
HE
guid
ance
Del
iver
ing
bett
er
oral
hea
lth
deliv
ered
by
ear
ly y
ears
sta
ff
durin
g al
l con
tact
s,
inte
rven
tions
and
in
info
rmat
ion
prov
ided
in
ear
ly y
ears
set
tings
ac
tiviti
es a
roun
d
heal
th, w
ellb
eing
, diet,
nutr
ition
and
par
entin
g
Incr
ease
d kn
owle
dge
of
pare
nts/
care
rs reg
ardi
ng t
he
appr
opria
te e
vide
nce
base
d or
al h
ealth
mes
sage
s
Early
Year
s st
aff m
ore
awar
e
oral
hea
lth
and
dent
al h
ealth
mes
sage
s.
Impr
oved
awar
enes
s in
pa
rent
s an
d fa
milies
abo
ut
oral
hea
lth
and
dent
al h
ealth.
Impr
oved
ora
l hea
lth
for
vuln
erab
le g
roup
s
Incr
ease
in a
cces
s to
prim
ary
NHS
dent
al s
ervice
s
Wor
k with
m
inim
um t
hree
co
mm
unity
se
ttin
gs
May
2018
Publ
ic H
ealth
Com
mun
icat
ions
Te
am
Publ
ic H
ealth
Engl
and
Early
Year
s Se
ttin
gs
Early
Hel
p Te
am
Publ
ic H
ealth
Team
019
With
in e
xist
ing
Reso
urce
3. S
tren
gthe
n co
mm
unity
action
4. D
evel
op P
erso
nal S
kills
22 Darlington Oral Health Plan 2017-2022
No
Key
Area
of
Action
Des
ired
Out
puts
Expe
cted
Out
com
esM
ilest
ones
Resp
onsi
bilit
ies
Fund
ing
Posi
tion
2a
2b
Max
imise
the
op
port
uniti
es in
the
Hea
lthy
Chi
ld P
rogr
amm
e fo
r th
e Hea
lth V
isito
rs
and
Scho
ol N
urse
s to
de
liver
evide
nce
base
d in
terv
entio
ns t
o pr
omot
e or
al a
nd d
enta
l hea
lth a
t ev
ery
cont
act.
Supp
ort
pare
nts
to
acce
ss p
rimar
y de
ntal
ca
re s
ervice
s fo
r ro
utin
e pr
even
tive
care
and
adv
ice
for th
eir ch
ildre
n. P
rom
ote
and
prov
ide
health
y ea
ting
thro
ugh
appl
icat
ion
of
existin
g gu
idel
ines
and
in
terv
entio
ns p
artic
ular
ly
thos
e ar
ound
sug
ar
redu
ctio
n.
Ensu
re o
ral h
ealth
to
be p
art
of c
are
plan
s fo
r ol
der
peop
le in
car
e ho
mes
and
upt
ake
of o
ral
health
tra
inin
g by
car
e st
aff.
A re
sour
ce g
uide
ha
s be
en d
evel
oped
al
ongs
ide
the
oral
he
alth
pla
n. It
sum
mar
ises
evide
nce
base
d m
essa
ges
and
sign
post
to
serv
ices
an
d re
sour
ces
for
oral
he
alth
pro
mot
ion
in
early
year
set
tings
.
A re
sour
ce in
clud
ing
a lis
t of
key
evide
nce
base
d m
essa
ges
arou
nd
oral
hea
lth
prom
otio
n fo
r ol
der
peop
le in
car
e ho
me
Redu
ctio
ns in
chi
ldre
n to
oth
deca
y le
vels
Incr
ease
d nu
mbe
rs o
f ch
ildre
n ac
cess
ing
NHS
dent
al s
ervice
s
Ora
l hea
lth
asse
ssm
ents
an
d m
outh
car
e pl
ans
for
olde
r re
side
nts
of c
are
hom
es in
clud
ed a
s pa
rt o
f co
ntra
ctua
l res
pons
ibilitie
s
June
2018
2019
May
2018
019
Serv
ice
(HDFT
)
And
Early
Year
s pa
rtne
rs
Com
mission
ers
and
cont
ract
tea
m in
ad
ult
and
social
ca
re
Car
e ho
me
man
ager
s
Hea
lth E
duca
tion
Engl
and
With
in t
he
existin
g en
velo
pe o
f fu
ndin
g
With
in t
he
existin
g en
velo
pe o
f fu
ndin
g
2. C
reat
e su
ppor
tive
env
ironm
ents
No
No
Key
Area
of
Action
Key
Area
of
Action
Des
ired
Out
puts
Des
ired
Out
puts
Expe
cted
Out
com
es
Expe
cted
Out
com
es
Mile
ston
es
Mile
ston
es
Resp
onsi
bilit
ies
Resp
onsi
bilit
ies
Fund
ing
Posi
tion
Fund
ing
Posi
tion
3a
4a
Use
soc
ial m
arke
ting
met
hods
to
prom
ote
or
al h
ealth
mes
sage
s with
in a
ran
ge o
f se
ttin
gs.
Prom
ote
Smile
Wee
k
Use
the
PHE
guid
ance
“D
eliver
ing
bett
er o
ral
health
” Ea
rly Y
ears
se
ttin
gs in
clud
ing
advice
ab
out
oral
hea
lth in
ro
utin
e co
ntac
ts a
nd
info
rmat
ion
arou
nd
health
, wel
lbeing
, sug
ary
snac
ks a
nd d
rinks
, die
t, nu
triti
on a
nd p
aren
ting.
Dev
elop
a ran
ge o
f m
essa
ges
incl
udin
g fo
r di
ssem
inat
ion
thro
ugh
social
med
ia t
hat
prom
ote
key
elem
ents
of
Ora
l and
Den
tal
Hea
lth
prom
otio
n with
co
mm
unicat
ions
tea
m
Key
mes
sage
s ba
sed
on t
he P
HE
guid
ance
Del
iver
ing
bett
er
oral
hea
lth
deliv
ered
by
ear
ly y
ears
sta
ff
durin
g al
l con
tact
s,
inte
rven
tions
and
in
info
rmat
ion
prov
ided
in
ear
ly y
ears
set
tings
ac
tiviti
es a
roun
d
heal
th, w
ellb
eing
, diet,
nutr
ition
and
par
entin
g
Incr
ease
d kn
owle
dge
of
pare
nts/
care
rs reg
ardi
ng t
he
appr
opria
te e
vide
nce
base
d or
al h
ealth
mes
sage
s
Early
Year
s st
aff m
ore
awar
e
oral
hea
lth
and
dent
al h
ealth
mes
sage
s.
Impr
oved
awar
enes
s in
pa
rent
s an
d fa
milies
abo
ut
oral
hea
lth
and
dent
al h
ealth.
Impr
oved
ora
l hea
lth
for
vuln
erab
le g
roup
s
Incr
ease
in a
cces
s to
prim
ary
NHS
dent
al s
ervice
s
Wor
k with
m
inim
um t
hree
co
mm
unity
se
ttin
gs
May
2018
Publ
ic H
ealth
Com
mun
icat
ions
Te
am
Publ
ic H
ealth
Engl
and
Early
Year
s Se
ttin
gs
Early
Hel
p Te
am
Publ
ic H
ealth
Team
019
With
in e
xist
ing
Reso
urce
3. S
tren
gthe
n co
mm
unity
action
4. D
evel
op P
erso
nal S
kills
Darlington Oral Health Plan 2017-2022 23
No
Key
Area
of
Action
Des
ired
Out
puts
Expe
cted
Out
com
esM
ilest
ones
Resp
onsi
bilit
ies
Fund
ing
Posi
tion
4b
4c
4d
Prov
ide
advice
on
brea
stfe
edin
g an
d in
fant
fe
edin
g pr
actic
es in
lin
e with
PHE
guid
ance
, Del
iver
ing
bett
er o
ral
health
HLS
sel
f re
port
ed
ques
tions
reg
ardi
ng
know
ledg
e, a
ttitu
des
and
beha
viou
rs a
roun
d de
ntal
an
d or
al h
ealth
to
be
includ
ed in
the
Hea
lthy
Life
style
Surv
ey for
Dar
lingt
on
Ensu
re t
hat
care
hom
e st
aff ac
cess
ava
ilabl
e tr
aini
ng o
n or
al h
ealth
fo
r ol
der
peop
le in
car
e ho
mes
.
Mid
wife
ry B
ooking
and
Po
st n
atal
info
rmat
ion
and
supp
ort
by
Mid
wife
ry a
nd a
ll m
anda
ted
visits
by
the
Hea
lth
Visito
r as
pa
rt o
f th
e HCP
in
Dar
lingt
on
Iden
tify
high
qua
lity
traini
ng t
hat
is a
vaila
ble
natio
nally
, reg
iona
lly
and
loca
lly.
Incl
ude
requ
irem
ent
for
traini
ng in
Ora
l Hea
lth
for
olde
r pe
ople
as
par
t of
con
trac
tual
re
spon
sibi
lities
for
Car
e Hom
es in
Dar
lingt
on.
Positiv
e Fe
edba
ck
from
par
ents
reg
ardi
ng
brea
stfe
edin
g an
d in
fant
fe
edin
g.
Tren
d in
form
atio
n av
aila
ble
to
info
rm p
lann
ing
serv
ices
Incr
ease
d kn
owle
dge
and
impr
oved
pra
ctice
in c
are
staf
f in
car
e ho
mes
.
Incr
ease
d nu
mbe
rs o
f Car
e St
aff with
evide
nce
of tra
ining
in O
ral H
ealth
Pro
mot
ion
rele
vant
to
their
client
s.
Ora
l and
den
tal h
ealth
incl
uded
in C
are
Plan
s fo
r re
side
nts
Review
Jun
e 2018
Dec
embe
r 2018
Review
Dec
embe
r 2019
Febr
uary
2019
Publ
ic H
ealth
Team
Mid
wife
ry
Serv
ice
CDDFT
CCG
Com
mission
ers
019
CDDFT
Mid
wife
ry
Serv
ices
Educ
atio
n an
d Pu
blic H
ealth
Publ
ic H
ealth
Tea
m
NHS
Engl
and
Loca
l Aut
horit
y Com
mission
ers
CCG c
omm
ission
ers
Car
e Hom
e pr
ovid
ers
With
in e
xist
ing
Reso
urce
With
in e
xist
ing
Reso
urce
24 Darlington Oral Health Plan 2017-2022
No
Key
Area
of
Action
Des
ired
Out
puts
Expe
cted
Out
com
esM
ilest
ones
Resp
onsi
bilit
ies
Fund
ing
Posi
tion
4b
4c
4d
Prov
ide
advice
on
brea
stfe
edin
g an
d in
fant
fe
edin
g pr
actic
es in
lin
e with
PHE
guid
ance
, Del
iver
ing
bett
er o
ral
health
HLS
sel
f re
port
ed
ques
tions
reg
ardi
ng
know
ledg
e, a
ttitu
des
and
beha
viou
rs a
roun
d de
ntal
an
d or
al h
ealth
to
be
includ
ed in
the
Hea
lthy
Life
style
Surv
ey for
Dar
lingt
on
Ensu
re t
hat
care
hom
e st
aff ac
cess
ava
ilabl
e tr
aini
ng o
n or
al h
ealth
fo
r ol
der
peop
le in
car
e ho
mes
.
Mid
wife
ry B
ooking
and
Po
st n
atal
info
rmat
ion
and
supp
ort
by
Mid
wife
ry a
nd a
ll m
anda
ted
visits
by
the
Hea
lth
Visito
r as
pa
rt o
f th
e HCP
in
Dar
lingt
on
Iden
tify
high
qua
lity
traini
ng t
hat
is a
vaila
ble
natio
nally
, reg
iona
lly
and
loca
lly.
Incl
ude
requ
irem
ent
for
traini
ng in
Ora
l Hea
lth
for
olde
r pe
ople
as
par
t of
con
trac
tual
re
spon
sibi
lities
for
Car
e Hom
es in
Dar
lingt
on.
Positiv
e Fe
edba
ck
from
par
ents
reg
ardi
ng
brea
stfe
edin
g an
d in
fant
fe
edin
g.
Tren
d in
form
atio
n av
aila
ble
to
info
rm p
lann
ing
serv
ices
Incr
ease
d kn
owle
dge
and
impr
oved
pra
ctice
in c
are
staf
f in
car
e ho
mes
.
Incr
ease
d nu
mbe
rs o
f Car
e St
aff with
evide
nce
of tra
ining
in O
ral H
ealth
Pro
mot
ion
rele
vant
to
their
client
s.
Ora
l and
den
tal h
ealth
incl
uded
in C
are
Plan
s fo
r re
side
nts
Review
Jun
e 2018
Dec
embe
r 2018
Review
Dec
embe
r 2019
Febr
uary
2019
Publ
ic H
ealth
Team
Mid
wife
ry
Serv
ice
CDDFT
CCG
Com
mission
ers
019
CDDFT
Mid
wife
ry
Serv
ices
Educ
atio
n an
d Pu
blic H
ealth
Publ
ic H
ealth
Tea
m
NHS
Engl
and
Loca
l Aut
horit
y Com
mission
ers
CCG c
omm
ission
ers
Car
e Hom
e pr
ovid
ers
With
in e
xist
ing
Reso
urce
With
in e
xist
ing
Reso
urce
No
Key
Area
of
Action
Des
ired
Out
puts
Expe
cted
Out
com
esM
ilest
ones
Resp
onsi
bilit
ies
Fund
ing
Posi
tion
5a
Wor
k with
den
tists
and
ot
her
prof
ession
al g
roup
s who
are
in c
onta
ct w
ith
indi
vidu
als
from
tho
se
com
mun
ities
mos
t at
ris
k from
ora
l can
cers
to
incr
ease
awar
enes
s ab
out
the
risk
fact
ors.
Incr
ease
d sc
reen
ing,
de
liver
y an
d sign
po
stin
g of
brie
f ad
vice
re
gard
ing
smok
ing
and
alco
hol.
Incr
ease
d up
take
of ro
utin
e de
ntal
ser
vice
s in
‘at
risk’
grou
ps a
nd c
omm
uniti
es.
Redu
ctio
n in
hig
h ris
k be
haviou
rs s
uch
as s
mok
ing
and
harm
ful a
lcoh
ol
cons
umpt
ion.
Earlier
dete
ctio
n an
d trea
tmen
t or
ora
l can
cers
.
Long
ter
m, i
mpr
oved
sur
viva
l ra
te in
tho
se d
iagn
osed
and
trea
ted
for
oral
can
cer
in
Dar
lingt
on
Review
Dec
embe
r 2019
Publ
ic H
ealth
Team
PHE
NHS
Engl
and
Hea
lth
Educ
atio
n En
glan
d
Loca
l Den
tal
Com
mitt
ee
CCG c
omm
ission
ers
CDDFT
Can
cer
Serv
ices
.
Prim
ary
Car
e
With
in e
xist
ing
Reso
urce
5. R
e-or
ient
hea
lth
care
ser
vice
s to
war
d pr
even
tion
of
illne
ss a
nd p
rom
otio
n of
hea
lth
Darlington Oral Health Plan 2017-2022 25
No
Key
Area
of
Action
Des
ired
Out
puts
Expe
cted
Out
com
esM
ilest
ones
Resp
onsi
bilit
ies
Fund
ing
Posi
tion
5b
Inte
grat
e ad
vice
abo
ut
oral
hea
lth a
s pa
rt o
f ro
utin
e in
form
atio
n th
at
is p
rovide
d ab
out
diet
, nu
triti
on a
nd p
aren
ting
as p
art
of h
ealth
and
wel
lbeing
inte
rven
tions
an
d in
form
atio
n th
at is
pr
ovid
ed t
o fa
milies
and
pa
rent
s by
all
Early
Yea
rs
staf
f.
Iden
tify
key
perfor
man
ce
Indi
cato
r(s)
to
be
incl
uded
in t
he c
urre
nt
019
arou
nd t
he p
rovision
of
oral
and
den
tal h
ealth
prom
otio
n as
par
t of
ro
utin
e co
ntac
ts d
urin
g 0 In
tegr
ated
into
Ea
rly
Year
s se
ttin
gs
asse
ssm
ents
pa
rticul
arly n
ew c
hild
as
sess
men
ts.
Cha
nges
in p
ract
ice
in a
ll ea
rly
year
s pr
actit
ione
rs a
nd
sett
ings
Incr
ease
d aw
aren
ess
of k
ey
mes
sage
s an
d ad
vice
for
fa
milies
and
par
ents
aro
und
oral
and
den
tal h
ealth.
Mea
sura
ble
impr
ovem
ent
in
cove
rage
and
exp
osur
e to
th
is in
form
atio
n an
d ad
vice
in
pare
nts.
Evid
ence
of a
sust
aine
d re
duct
ion
in t
he m
easu
re o
f to
oth
deca
y in
5 y
ear
old
child
ren
Redu
ctio
n in
mos
t se
vere
to
oth
deca
y/Se
psis d
ue t
o de
ntal
dec
ay in
chi
ldre
n un
der
5 y
ears
.
June
2018
Publ
ic H
ealth
Team
NHS
Engl
and
019
Early
Year
s Pr
ovid
ers
DBC
Hea
d of
Ed
ucat
ion
(30
hour
s st
atut
ory
prov
isio
n)
With
in e
xist
ing
Reso
urce
No
Key
Area
of
Action
Des
ired
Out
puts
Expe
cted
Out
com
esM
ilest
ones
Resp
onsi
bilit
ies
Fund
ing
Posi
tion
5c
Incr
ease
kno
wle
dge
abou
t or
al h
ealth
am
ong
fron
t lin
e pr
ofes
sion
als
wor
king
with
vul
nera
ble
C&YP
and
frail o
lder
peo
ple
in c
are
hom
es in
Dar
lingt
on
Fron
tlin
e he
alth
and
so
cial
car
e st
aff
wor
king
with
vul
nera
ble
child
ren
and
youn
g pe
ople
as
wel
l as
frail o
ld p
eopl
e in
ca
re h
omes
give
cons
iste
nt a
nd e
vide
nce
base
d ad
vice
on
the
impo
rtan
ce o
f or
al
heal
th.
Incr
ease
d up
take
of tr
aini
ng
in h
ealth
and
social
car
e pr
ofes
sion
als
Incr
ease
d nu
mbe
r of
den
tal
heal
th c
heck
s in
tho
se
child
ren
that
are
Loo
ked
Afte
r as
par
t of
the
sta
tuto
ry
Hea
lth
Asse
ssm
ents
.
Impr
oved
ora
l hea
lth
for
vuln
erab
le g
roup
s in
fut
ure
oral
hea
lth
epid
emio
logi
cal
surv
ey.
Incr
ease
in n
umbe
rs o
f ol
der
peop
le res
iden
ts a
re li
ving
in
care
hom
es w
ho a
re rec
eive
do
miciliar
y de
ntal
che
cks
incl
udin
g fo
r th
ose
with
pa
rtial o
r co
mpl
ete
dent
ures
.
June
2018
and
June
2019
Hea
lth
Educ
atio
n En
glan
d
Publ
ic H
ealth
team
, DBC
Com
mission
ers
PHE
Social
car
e
Car
e Hom
e pr
ovid
ers
Loca
l Den
tal
Com
mitt
ee
With
in e
xist
ing
Reso
urce
26 Darlington Oral Health Plan 2017-2022
No
Key
Area
of
Action
Des
ired
Out
puts
Expe
cted
Out
com
esM
ilest
ones
Resp
onsi
bilit
ies
Fund
ing
Posi
tion
5b
Inte
grat
e ad
vice
abo
ut
oral
hea
lth a
s pa
rt o
f ro
utin
e in
form
atio
n th
at
is p
rovide
d ab
out
diet
, nu
triti
on a
nd p
aren
ting
as p
art
of h
ealth
and
wel
lbeing
inte
rven
tions
an
d in
form
atio
n th
at is
pr
ovid
ed t
o fa
milies
and
pa
rent
s by
all
Early
Yea
rs
staf
f.
Iden
tify
key
perfor
man
ce
Indi
cato
r(s)
to
be
incl
uded
in t
he c
urre
nt
019
arou
nd t
he p
rovision
of
oral
and
den
tal h
ealth
prom
otio
n as
par
t of
ro
utin
e co
ntac
ts d
urin
g 0 In
tegr
ated
into
Ea
rly
Year
s se
ttin
gs
asse
ssm
ents
pa
rticul
arly n
ew c
hild
as
sess
men
ts.
Cha
nges
in p
ract
ice
in a
ll ea
rly
year
s pr
actit
ione
rs a
nd
sett
ings
Incr
ease
d aw
aren
ess
of k
ey
mes
sage
s an
d ad
vice
for
fa
milies
and
par
ents
aro
und
oral
and
den
tal h
ealth.
Mea
sura
ble
impr
ovem
ent
in
cove
rage
and
exp
osur
e to
th
is in
form
atio
n an
d ad
vice
in
pare
nts.
Evid
ence
of a
sust
aine
d re
duct
ion
in t
he m
easu
re o
f to
oth
deca
y in
5 y
ear
old
child
ren
Redu
ctio
n in
mos
t se
vere
to
oth
deca
y/Se
psis d
ue t
o de
ntal
dec
ay in
chi
ldre
n un
der
5 y
ears
.
June
2018
Publ
ic H
ealth
Team
NHS
Engl
and
019
Early
Year
s Pr
ovid
ers
DBC
Hea
d of
Ed
ucat
ion
(30
hour
s st
atut
ory
prov
isio
n)
With
in e
xist
ing
Reso
urce
No
Key
Area
of
Action
Des
ired
Out
puts
Expe
cted
Out
com
esM
ilest
ones
Resp
onsi
bilit
ies
Fund
ing
Posi
tion
5c
Incr
ease
kno
wle
dge
abou
t or
al h
ealth
am
ong
fron
t lin
e pr
ofes
sion
als
wor
king
with
vul
nera
ble
C&YP
and
frail o
lder
peo
ple
in c
are
hom
es in
Dar
lingt
on
Fron
tlin
e he
alth
and
so
cial
car
e st
aff
wor
king
with
vul
nera
ble
child
ren
and
youn
g pe
ople
as
wel
l as
frail o
ld p
eopl
e in
ca
re h
omes
give
cons
iste
nt a
nd e
vide
nce
base
d ad
vice
on
the
impo
rtan
ce o
f or
al
heal
th.
Incr
ease
d up
take
of tr
aini
ng
in h
ealth
and
social
car
e pr
ofes
sion
als
Incr
ease
d nu
mbe
r of
den
tal
heal
th c
heck
s in
tho
se
child
ren
that
are
Loo
ked
Afte
r as
par
t of
the
sta
tuto
ry
Hea
lth
Asse
ssm
ents
.
Impr
oved
ora
l hea
lth
for
vuln
erab
le g
roup
s in
fut
ure
oral
hea
lth
epid
emio
logi
cal
surv
ey.
Incr
ease
in n
umbe
rs o
f ol
der
peop
le res
iden
ts a
re li
ving
in
care
hom
es w
ho a
re rec
eive
do
miciliar
y de
ntal
che
cks
incl
udin
g fo
r th
ose
with
pa
rtial o
r co
mpl
ete
dent
ures
.
June
2018
and
June
2019
Hea
lth
Educ
atio
n En
glan
d
Publ
ic H
ealth
team
, DBC
Com
mission
ers
PHE
Social
car
e
Car
e Hom
e pr
ovid
ers
Loca
l Den
tal
Com
mitt
ee
With
in e
xist
ing
Reso
urce
Darlington Oral Health Plan 2017-2022 27
Darlington Oral Health Plan2017-2022
Acknowledgements Report Author: Dr. Balsam Ahmad, Speciality Registrar in Public Health, Public Health Team, Darlington Borough Council
This is to acknowledge the support and input from the following individuals and organisations:Dr. David Landes and Dr. Kamini Shah, Consultants in Dental Public Health at Public Health England Dr. Az Hyder, Chair of Burgess-Hyder Dental Group and Chair of the Local Dental Committee; Caroline Gregory, Practice Manager and Oral Health Educator at Burgess-Hyder Dental Group; Rachel Fitzsimons; Health Education England Yvonne Hall, DBC; Jeanette Crompton, DBC; Catherine Shaw, RESH Co-ordinator for DBC;
Dr. Frederike Garb; author of the oral health strategy for Northumberland County Council; Dr. Jonathan Lewney, (author of the Oral Health Strategy for Newcastle City Council); Miriam Davidson, Director of Public Health, Ken Ross, Public Health Principal, Rachel Osbaldeston, Public Health Portfolio Lead, Zoe Foster, Analyst in the Public Health Team and Pauline Brown, Administrator, DBC.
For further information please contact [email protected]